Customer Authorization Of Disclosure Of Financial Records {DFPI-QR 500.259}

DFPI-QR 500.259, CUSTOMER AUTHORIZATION OF DISCLOSURE OF FINANCIAL RECORDS, The Commissioner of Financial Protection and Innovation is authorized to require such authorization from certain licensees and other persons pursuant to the authority cited in the first paragraph of the form. The form must be properly executed and submitted with the attached application for license, qualification, registration or other authority. All information required on the form, except the signature of the person executing the form, is to be typewritten. If the form requests a Department of Financial Protection and Innovation file number, the applicant need only provide such number if it is known to the applicant and is the type of file number appropriate for the license, qualification, registration or other authority applied for in the attached application. If additional authorization forms are needed, they may be obtained from any office of the Department of Financial Protection and Innovation, or accurate copies of the form may be utilized by applicants. (Rev. 11-20). www.FormsWorkflow.com